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Shenjing shuairuo

Many psychiatrists in communist China between the 1950s and the 1970s reported patients showing symptoms of shenjing shuairuo, which translates as ‘nerve weakness’. The reports came soon after the neurasthenia diagnosis fell out of use among psychiatrists in North America and Europe. The term shenjing shuairuo had appeared in Chinese medical writings in the early 1900s, particularly in translations of European and American writing on neurasthenia.

In the 1980s an influential American psychiatrist and anthropologist made controversial allegations about shenjing shuairuo. He said this supposed epidemic was an attempt to disguise high rates of depression, and dissatisfaction with a repressive regime, as nerve illness rather than mental illness. Many psychiatrists in China rejected the implication neurasthenia was a myth, but many psychiatrists outside China saw the existence of such a ‘myth’ as justifiable. They said it was necessary in an environment where sadness, despair and fatigue could be interpreted as lack of dedication to the communist revolution. In other words, like neurasthenia and nervous breakdown, the diagnosis protected people from some of mental illness’s most painful social consequences.

The diagnosis of shenjing shuariuo began disappearing in China around the year 2000. This was especially true in urban areas, and among Chinese psychiatrists trained in Europe and North America. Anthropologists have attributed this change to economic reforms improving the quality of life, increased freedom to discuss psychological and emotional problems, and the global influence of Western psychiatry. The Diagnostic and Statistical Manual (DSM), for example, recognises depression but not neurasthenia. Another factor is foreign companies marketing antidepressants in China. They widely publicised the anthropological argument that neurasthenia was ‘really’ depression in disguise, because it enlarged the market for such medications.